Browsing by Subject "Obstetrics and gynecology"

Every day, approximately 800 women die from pregnancy-related complications. Most of these deaths are avoidable. Care from a skilled provider before, during, and after delivery has been shown to prevent a majority of maternal and neonatal deaths. However, time delays in recognizing the need to seek care, accessing health care facilities, and receiving adequate care from a provider of make the delivery of effective maternal healthcare practices very challenging. These three delays disproportionately affect women living in rural and remote regions, where awareness of maternal health problems can be low and health facilities are few and far between. In Kenya, maternal health care in these regions falls upon community health volunteers, who are unpaid and overworked.

In recent years, mobile phones have grown in popularity for improving disease prevention and management, especially in the field of maternal and child health. The intent of this study was to design and pilot a mobile phone-based patient management system intended for use by community health volunteers. Using a human-centered design framework, a system was developed to fit into the CHVs' existing workflows in order to improve the delivery of maternal and child health care at the community level. Integrating both voice and text messaging interfaces, the system was designed to provide the CHVs with a fast and easy method of recording and reporting data, a streamlined approach for tracking patient referrals to a health facility, and a reliable and effective way to report and respond to obstetric emergencies. The system was found to be highly usable based on self-report data from users, who indicated that the system saved them time and helped them complete their responsibilities as CHVs. In all, results of this pilot suggest that such a system may be useful for CHVs in monitoring the health of pregnant women over time and helping to avoid the time delays associated with maternal mortality.

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There is little information regarding the knowledge, attitudes and practices of obstetric care providers in Rwanda, who are a crucial component for providing quality Safe Motherhood care. Despite investments in the structural capacity needed to deliver these services, little has been directed towards understanding the current competency of skilled providers on the front lines of maternal mortality and morbidity prevention. This study surveyed 87% of all obstetric care providers in the Bugesera District of Rwanda to determine their demographic characteristics, competency in Safe Motherhood knowledge, obstetric practices, and attitudes towards patients and training approaches. The study identified the majority of providers to be A2 level nurses (82%) who have received one year of health education in secondary school. In addition, the majority of providers expressed that both their knowledge (60.6%) and skills confidence (72.2%) across fundamental topics of Safe Motherhood care need improvement. There was a low level of demonstrated knowledge in Safe Motherhood services with a mean of 46.4% of 50 questions answered correctly. Performance of knowledge in normal labor (39.3% correct) and obstetric complications (37.1% correct) were the weakest areas identified. A high percentage of providers (60.8%) engage in the potentially harmful practice of fundal pressure during vaginal delivery, while only 15.9% of providers practice steps of the active management of the third stage of labor in 100% of their deliveries. Providers view additional education and training in emergency obstetric care (EMOC) to be very useful, with 89.3% reporting an enthusiastic willingness for participation in a two-day workshop even if it was their day off. Improving knowledge, skills and practices of obstetric providers is an essential step in improving the quality of emergency obstetric care.

Even though women make up over half the population in the United States, medical advancements in areas of women's health have typically lagged behind the rest of the medical field. Specifically, two major threats to women's reproductive health include human immunodeficiency virus (HIV), and cervical cancer with accompanying human papillomavirus (HPV) infection. This dissertation presents the development and application of two novel optical imaging technologies aimed at improving these aspects of women's reproductive health.

The presented work details the instrumentation development of a probe-based, dual-modality optical imaging instrument, which uses simultaneous imaging of fluorimetry and multiplexed low coherence interferometry (mLCI) to measure in vivo microbicide gel thickness distributions. The study explores the optical performance of the device and provides proof of concept measurements on a calibration socket, tissue phantom, and in vivo human data. Once the instrument is fully characterized, it is applied in a clinical trial in which in vivo human vaginal gel thickness distributions. The gel distribution data obtained by the modalities are compared in order to assess the ability of mLCI making accurate in vivo measurements. Differences between the fluorimetry and mLCI modalities are then exploited in order to show a methodology for calculating the extent of microbicide gel dilution with the dual-modality instrument data.

Limitations in cervical cancer screening are then addressed as angle-resolved low coherence interferometry (a/LCI) is used in an ex vivo pilot study to assess the feasibility of a/LCI in identifying dysplasia in cervical tissues. The study found that the average nuclear diameter found by a/LCI in the basal layer of ectocervical epithelium showed a statistically significant increase in size in dysplastic tissue. These results indicate that a/LCI is capable of identifying cervical dysplasia in ectocervical epithelium. The results of the work presented in this dissertation show that dual-modality optical imaging with fluorimetry and mLCI, and the a/LCI technique show promise in advancing technologies that are used in the field of women's reproductive health.

Up to two million women worldwide have obstetric fistula, a maternal morbidity prevalent in developing countries that causes uncontrollable leaking of urine and/or feces and a persistent bad odor. There is both theoretical and empirical evidence for psychopathology in patients presenting for fistula surgery, albeit with methodological limitations. The current studies sought to improve on past limitations of study design. Study A compared psychological symptoms and social support between fistula patients and a comparison group recruited from gynecology outpatient clinics. Measures included previously validated psychometric questionnaires, administered orally by data collectors. Results showed that compared to gynecology outpatients, fistula patients had significantly higher levels of depression, traumatic stress, somatic symptoms and avoidant coping, and had lower social support. Study B investigated changes in psychological symptoms, stigma and social support between the time of admission for fistula repair and 3 months after discharge from the hospital. At follow-up, fistula patients reported significant improvements in all study outcome variables. Exploratory analysis revealed that the extent of leaking was associated with depression and PTSD. These results indicate the potential benefit of mental health interventions for this population. Additionally, future research may clarify the relationship between residual leaking after fistula surgery, and its effect on post-surgery mental health outcomes.